A 42-year-old male with known alcoholic liver disease who is still drinking alcohol is brought in by relatives with a three-day history of worsening confusion. On examination he is confused with marked abdominal distension and generalised tenderness. His vital signs are temperature 35°C, HR 70/min, BP 90 systolic, saturations 98% on 6 L oxygen via Hudson mask.

1. Outline six potential causes of confusion in this man with a relevant investigation for each. 6 marks

During your assessment, he passes a large melaena stool. His BP drops to 70 systolic.

2. Outline six specific interventions to manage this patient. 6 marks